complications of abdominal surgery
TRANSCRIPT
Complications of surgery
A. Thangamani ramalingam PT, MSc(PSY), MIAP
complications Respiratory Circulatory Wound related Joint mobility/muscle weakness Postural deformity others
Atelectasis Increased temperature, pulse &
respiratory rate Flushed/feverish patient Tightness/discomfort of the affected
side Poor chest expansion X-ray reveals collapse of lung
In first 48 hrs after surgery
Painful /impaired respiration Reflex inhibition of diaphragmatic
movement due to pain &anaesthesia Difficulty in coughing Weak abdominal muscles Cough reflex inhibition due to
analgesia Accumulation of secretions
Pneumonia Aspiration pneumonia
hemodynamics
Decreases-thrombosis, ischemia &infarction
Increases- hemorrhage, edema &hyperemia
Thrombosis/Greek-clot Increased temp Tender/swollen calf Red/shiny skin Homan’s test positive Engorged veins/edema Cord like veins Pain along the course of the vein
Deep vein thrombosis
Risk of DVT may begin during,in24-48hrs or late as 3 months of surgery
Homans' sign is a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees.
Pratt's sign is an indication of femoral deep vein thrombosis. It is seen as the presence of dilated pretibial veins in the affected leg, which remain dilated on raising the leg.
The sign was described by American surgeon Gerald H. Pratt of St. Vincent's Hospital in 1949
Wells score or criteria: (Possible score -2 to 9) Active cancer (treatment within last 6 months or
palliative) +1 point Calf swelling >3 cm compared to other calf
(measured 10 cm below tibial tuberosity) +1 point Collateral superficial veins (non-varicose) +1 point Pitting edema (confined to symptomatic leg) +1
point Previous documented DVT +1 point. Swelling of entire leg +1 point Localized pain along distribution of deep venous system
+1 point Paralysis, paresis, or recent cast immobilization of lower
extremities +1 point Recently bedridden > 3 days, or major surgery requiring
regional or general anesthetic in past 4 weeks +1 point
Alternative diagnosis at least as likely -2 points
Interpretation: Score of 2 or higher — deep vein
thrombosis is likely. Consider imaging the leg veins.
Score of less than 2 — deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis.
DVT complications(long term) Night pain Venous ulceration edema
Diagnostic tests Duplex ultra sound Venography Impedance plethysmography MRI D-dimer blood test
Prevention of DVT Heparin Warfarin Aspirin Dextran Compression devices
embolism Greek-wedge/stopper
Pulmonary embolism Increased temperature, pulse & respiratory
rate Changes in patient color Severe chest pain/dysnea Pleurisy/blood stained sputum Cough, diaphoresis, apprehension Fever Bulging neck veins Altered mental status
Clinical findings of PE ST segment depression or T wave
inversion Right axis deviation Right bundle branch block
infarction Latin-stuffed
Limb infarction is an infarction of an arm or leg. Causes include arterial embolisms and skeletal muscle infarction as a rare complication of long standing, poorly controlleddiabetes mellitus. A major presentation is painful thigh or leg swelling.
oedema General Cardiac Renal Malnutrition/star
vation
Local Inflammatory Obstructive Paralytic Gravitational hereditary
causes increased hydrostatic pressure; reduced oncotic pressure within blood vessels; increased tissue oncotic pressure; increased blood vessel wall permeability e.g.
inflammation; obstruction of fluid clearance via the
lymphatic system; changes in the water retaining properties of the
tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.
mechanism Generation of interstitial fluid is regulated by the
forces of the Starling equation. Hydrostatic pressure within blood vessels tends to cause water to filter out into the tissue. This leads to a difference in protein concentration between blood plasma and tissue. As a result the oncotic pressure of the higher level of protein in the plasma tends to suck water back into the blood vessels from the tissue. Starling's equation states that the rate of leakage of fluid is determined by the difference between the two forces and also by the permeability of the vessel wall to water, which determines the rate of flow for a given force imbalance.
types Pit oedema-watery low protein content
Inflammatory oedema-thick fluid with high protein content
hemorrhage Revealed and concealed hemorrhage Primary/reactionary/secondary hemorrhage
Surgical/non surgical hemorrhage
Altered pulse & resp rate
Hemorrhagic shock Class 1- <15% Class 2- 15-30% Class 3- 30-40% Class 4- <40%
Blood transfusion Whole blood Packed red cells Fresh-frozen
plasma Cryoprecipitate Platelets Prothrombin
complex concentrates
Autologus blood
Indication Acute loss Anemia <6g/dl
Pressure soreStages Blanching Hyperemia Pressure area sore
Grades1to4
Sepsis (from Gr. the state of putrefaction or
decay) is a potentially deadly medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues.
Increased temp,resp.rate &heart rate Severe sepsis is the systemic inflammatory response, plus infection, plus the presence of organ dysfunction.
A lay term for sepsis is blood poisoning, also used to describe septicemia.
shock
The typical signs of shock are low blood pressure, a rapid heartbeat and signs of poor end-organ perfusion or "decompensation" (such as low
urine output, confusion or loss of consciousness Hypovolaemic shock Cardiogenic shock Distributive shock includes infectious,
anaphylactic and neurogenic causes
General muscle weakness Loss of mobility
Hiccough Vomiting Urine retention Abdominal distension Peritonitis Burst abdomen Paralytic ileus Renal failure
Urinary calculai UTI Incontinence Insomnia/depression Loss of appetite/weight Constipation Indigestion Less efficient immune system Sluggish liver &renal function Postural hypotension/supine hypotensive syndrome
Wound infection
Postoperative wound infection is an infection in the tissues of the incision and operative area. It can occur from 1 day to many years after an operation but commonly occurs between the fifth and tenth days after surgery.
pain, tenderness, localized swelling, redness, or heat.
microbes flourishing in the surgical site because of poor preoperative preparation, wound contamination, poor antibiotic selection, or the inability of an immuno compromised patient to fight off infection.
Factors increasing an individual's risk include malnutrition, decreased blood volume, lengthy preoperative stay, hypothermia, poor tissue perfusion, diabetes, and the use of immunosuppressant's such as steroids
Advanced age and obesity increase an individual's risk of having infection at the surgical site
Wound infection can cause separation of the wound layers, incisional hernias, abscesses, and tissue destruction (gangrene or necrotizing fasciitis), which can result in physical and/or functional deformity. Bacteria from the infection can spread, causing an overwhelming, life-threatening, systemic infection (sepsis).
Kypho-scoliosis
thank you